ROCKFORD — West Pearl Avenue. Pearl Street. At best, it’s an aggravation if the mail carrier should get the two streets mixed up. But it could be a matter of life and death if an ambulance service does.

That was the case May 26 when an OSF Lifeline Ambulance, a private service under contract with the city, mistakenly went to West Pearl Avenue in northwest Rockford to transport a shooting victim.

They were supposed to go to Pearl Street, just north of Charles Street.

On Thursday — more than seven weeks after Andrew Barth, 21, of Rockford was shot in the 500 block of Pearl Street — the Rockford Fire Department released an eight-page report. It details why the initial ambulance never responded and how 35 minutes elapsed between the initial call for an ambulance and Barth’s arrival at SwedishAmerican Hospital eight blocks away.

The Memorial Day shooting was reported at 1:16 p.m., a time at which all seven of the Fire Department’s ambulances were on calls and unavailable.

OSF Lifeline accepted the call and was dispatched at 1:17 p.m. from its Roxbury Road facility near OSF Saint Anthony Medical Center. Seventeen minutes passed with no sign of an ambulance. That’s when the Fire Department called for one of its ambulances that had just finished up at a call.

Barth plans to voice his frustrations to alderman Monday. “I want City Council to hear about it. You don’t privatize first responders.”

Barth also received a copy of the report, which includes a timeline of events.

He noted that nearly three minutes passed from the time the ambulance realized it went to the wrong location to Rockford firefighters treating his son being told that another ambulance was five to seven minutes away.

“That’s a big problem,” he said. “That’s complete negligence. No one told (the firefighters) ‘the ambulance you are waiting on is not coming. They are sending another one’.”

Winnebago County Coroner Sue Fiduccia said the autopsy gave no indication of whether the younger Barth would be alive had an ambulance arrived in a timely manner.

Page 2 of 2 - “I feel very sorry for the family about what happened, but I can’t prove that it would have made a difference,” she said, and firefighters/paramedics “can’t stop internal bleeding.”

Before the report was released, Chief Derek Bergsten said the city’s seven ambulances are typically on calls at the same time at least once a day, causing the Fire Department to rely on OSF Lifeline and four other private ambulance companies for contracted service.

Before the city’s five-ambulance fleet was bumped up to seven in June 2013, outside ambulance companies were being called up to six times a day.

In the first five months of the year, private ambulances were called once a day on average, Bergsten said.

City officials and OSF Lifeline declined to comment on the report’s findings and recommendations. Among them is that contracted private ambulance service providers should:

— Complete a driver safety course and map-book training.

— Install and use automatic vehicle locators in all ambulances to allow a dispatcher to track their location.

— Establish a verbal protocol between a dispatcher and ambulance operator to verify that the correct address was received.

— Receive updates for the map books annually from the Fire Department.

Still, Barth is against privatization of ambulance service.

“The problem is going to happen again,” he said. “It’s probably happened before. How many people have to die before they make the right decision.”